Article(id=1241102819403551004, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405054, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1714924800000, receivedDateStr=2024-05-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831570721, onlineDateStr=2026-03-18, pubDate=1724515200000, pubDateStr=2024-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831570721, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831570721, creator=13701087609, updateTime=1773831570721, updator=13701087609, issue=Issue{id=1241102813938380911, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831569418, creator=13701087609, updateTime=1773831807198, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103811318706322, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103811318706323, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2972, endPage=2976, ext={EN=ArticleExt(id=1241102819831370037, articleId=1241102819403551004, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research progress on cognitive health promotion of the elderly in county area, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=

Health promotion is a process that urges people to maintain and improve their own health, which can reduce the deterioration rate of cognitive function of the elderly or delay the decline of cognitive ability. However, the health promotion behavior and lifestyle of the elderly in the county are affected by many factors. Searching the existing databases, this paper reviews the related research on the health promotion of cognitive function of the elderly in the county area at home and abroad, including the related research on screening tools and health promotion intervention programs, compares the research on intervention programs, and puts forward the future research direction based on the county background in China. The purpose of this study is to provide a reference for Chinese scholars to effectively carry out health promotion strategies for the cognitive function of the elderly in county areas.

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健康促进是促使人们维护和改善他们自身健康的过程,能降低老年人认知功能的恶化速度或延缓认知能力水平下降。然而,县域老年人健康促进行为、生活方式受多方面因素影响。本文通过检索现有数据库,对国内外县域老年人认知功能健康促进的相关研究进行综述,包括筛查工具、健康促进干预方案的相关研究,并对干预方案的研究进行比较,结合我国县域背景提出未来研究方向,旨在为我国学者有效开展县域老年人认知功能健康促进策略提供借鉴。

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李博,E-mail:
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马国会(1995—),女,硕士在读,研究方向:慢病护理

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马国会(1995—),女,硕士在读,研究方向:慢病护理

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马国会(1995—),女,硕士在读,研究方向:慢病护理

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refs=[Reference(id=1241102824705151601, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102819403551004, doi=null, pmid=null, pmcid=null, year=2021, volume=17, issue=12, pageStart=1966, pageEnd=1975, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Rajan KB, Weuve J, Barnes LL, journalName=Alzheimer’s & Dementia : the Journal of the Alzheimer’s Association, refType=null, unstructuredReference=Rajan KB, Weuve J, Barnes LL, et al. 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县域老年人认知健康促进的研究进展
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马国会 , 李博 , 李思思 , 刘孟慧 , 马苗苗 , 王芝怡
现代预防医学 | 基层卫生服务 2024,51(16): 2972-2976
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现代预防医学 | 基层卫生服务 2024, 51(16): 2972-2976
县域老年人认知健康促进的研究进展
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马国会, 李博 , 李思思, 刘孟慧, 马苗苗, 王芝怡
作者信息
  • 河南大学护理与健康学院,河南 开封 475000
  • 马国会(1995—),女,硕士在读,研究方向:慢病护理

通讯作者:

李博,E-mail:
Research progress on cognitive health promotion of the elderly in county area
Guo-hui MA, Bo LI , Si-si LI, Meng-hui LIU, Miao-miao MA, Zhi-yi WANG
Affiliations
  • School of Nursing and Health, Henan University, Kaifeng, Henan 475000, China
出版时间: 2024-08-25 doi: 10.20043/j.cnki.MPM.202405054
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健康促进是促使人们维护和改善他们自身健康的过程,能降低老年人认知功能的恶化速度或延缓认知能力水平下降。然而,县域老年人健康促进行为、生活方式受多方面因素影响。本文通过检索现有数据库,对国内外县域老年人认知功能健康促进的相关研究进行综述,包括筛查工具、健康促进干预方案的相关研究,并对干预方案的研究进行比较,结合我国县域背景提出未来研究方向,旨在为我国学者有效开展县域老年人认知功能健康促进策略提供借鉴。

老年人  /  认知功能  /  县域  /  健康促进

Health promotion is a process that urges people to maintain and improve their own health, which can reduce the deterioration rate of cognitive function of the elderly or delay the decline of cognitive ability. However, the health promotion behavior and lifestyle of the elderly in the county are affected by many factors. Searching the existing databases, this paper reviews the related research on the health promotion of cognitive function of the elderly in the county area at home and abroad, including the related research on screening tools and health promotion intervention programs, compares the research on intervention programs, and puts forward the future research direction based on the county background in China. The purpose of this study is to provide a reference for Chinese scholars to effectively carry out health promotion strategies for the cognitive function of the elderly in county areas.

The elderly  /  Cognitive function  /  County area  /  Health promotion
马国会, 李博, 李思思, 刘孟慧, 马苗苗, 王芝怡. 县域老年人认知健康促进的研究进展. 现代预防医学, 2024 , 51 (16) : 2972 -2976 . DOI: 10.20043/j.cnki.MPM.202405054
Guo-hui MA, Bo LI, Si-si LI, Meng-hui LIU, Miao-miao MA, Zhi-yi WANG. Research progress on cognitive health promotion of the elderly in county area[J]. Modern Preventive Medicine, 2024 , 51 (16) : 2972 -2976 . DOI: 10.20043/j.cnki.MPM.202405054
随着认知功能下降的患病率不断增加,老年人认知功能下降已成为众多学者关注的公共卫生问题[1]。根据第七次全国人口普查数据显示,我国大陆地区60岁及以上的老年人占总人口的18.7%[2]。县域地区60岁及以上老年人口已占全国老年人口的65%以上,县域人口高龄化率达到13.6%,农村老年人主要在其所在县域范围内医院就医,且超过1/4的农村老年人患有轻度认知障碍(mild cognitive impairment,MCI)[3-5]。有关数据显示,农村老年人认知能力水平低于城市老年人,农村老年人认知障碍率是城市老年人的2.2倍[6-7]。与城市老年人相比,农村老年人面临MCI或阿尔茨海默病和相关痴呆症(Alzheimer’s disease and related dementias,ADRD)的风险增加[8]。县域是我国最基本的行政单位,是联系城乡的关键节点,是实现“以健康为中心”代替“以治疗为中心”的关键平台[9-10]。然而,我国县域普遍存在医疗资源分布不均、医疗服务质量和能力水平较低、城乡老年人健康素养存在差异性、农村医疗资源与现实需求不相适应且内部医疗资源配置结构失衡等问题[11-13]。因此在县域开展合理、有效的老年人认知功能健康促进方案对实现“健康中国”战略具有不可忽视的作用。本文就以往国内外县域老年人认知功能健康促进的研究进行综述,以期为我国深入开展县域老年人认知功能健康促进工作提供参考。
《渥太华宪章》明确提出健康促进是促使人们维护和改善他们自身健康的过程[14],包括疾病筛查、健康教育等医疗服务[15]。老年人健康促进是《“健康中国2030”规划纲要》的重要组成部分,也是各界学者关注的热点[16]。大多数认知障碍相关疾病通常起病隐匿、进展缓慢,阿尔兹海默病的病理生理进程在临床痴呆期之前的15~20年就已经开始[17]。早期进行脑认知健康促进是预防认知障碍相关疾病的关键。我国农村居民的健康素养水平低于城市居民,因此,应根据基层实际情况采取合适且高效的健康促进计划来改善县域老年人认知功能。
程彦如等[18]对河南省某县失能老年人的健康行为状况及影响因素进行调查,结果显示农村失能老年人健康行为总分明显低于城市老年人,文化程度和自我效能是健康行为的保护因素。我国县域约32.01%的老年人有0~2种促进健康行为,农村、学历较低、人均年收入低是主要影响因素[19]。因此在县域开展健康促进应重点关注农村、文化水平较低的老年人。老年自我忽视是农村慢性病老年人健康促进生活方式的独立危险因素,其中心理自我忽视与健康促进生活方式相关性最强,医疗自我忽视得分最高[20]。这提示农村地区卫生工作者应采取针对性的方案促使老年人主动关注健康、重视健康,进而抑制老年自我忽视的发生和发展,提升老年人的健康素养,促使他们形成健康促进行为和生活方式,以此提高县域地区老年人的整体健康水平。
对县域老年人进行认知功能筛查时应考虑到人口占比大、老年人受教育水平较低、医疗资源紧缺、卫生人员学历和能力较低等现象。因此,筛查工具应简短、具有教育公平性、易于理解和评分、无需特殊培训或培训较少等特点,以简化筛查过程。目前,蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)、简易智力状态检查量表(mini-mental state examination,MMSE)及其改编量表[21]、测试你的记忆(Test Your Memory,TYM)[22]、全科医生认知评估(General Practitioner assessment of Cognition,GPCog)[22]、痴呆症简要社区筛查工具(Brief Community Screening Instrument for Dementia,BCSI-D)[23]等被应用于开展县域老年人认知功能筛查。《脑认知健康管理中国专家共识(2023)》(以下简称《共识》)推荐MoCA用于MCI筛查,MMSE用于痴呆筛查,二者被评为认知障碍初筛的金标准[17,24],但需对筛查人员进行培训且耗时较长、易受教育水平的影响[25]。“MoCA—基础”是专门为文盲受试者开发的筛查工具[26],更适合文化水平普遍较低的县域老年人。在资源匮乏、专家可及性有限的城乡初级保健机构中,TYM和GPCog是认知功能筛查的最佳选择,可由全科医生或经过较少培训的卫生人员进行管理[22]。BCSI-D具有教育公平性,能获得本人和照顾者的信息,易于理解和实施、省时省力,可由非专业医疗者执行,适用于农村老年人痴呆症的筛查[27]
我国县域地区经济落后、健康资源有限、老年人受教育水平较低,因此,在开展老年人认知功能健康促进时,方案应考虑不受地点和时间限制、低成本、低风险、无需特殊设备、具有教育公平性。八段锦、太极拳等传统养生体育项目深受我国老年人喜爱[28],且能提高人体交感神经和副交感神经协调能力,对大脑皮层起着抑制性保护作用,使自主神经系统维持着动态且相对的平衡[29]。刘童童[30]对某县老年人进行太极拳练习,12周后,MMSE和MoCA得分高于干预前,抑制、刷新和转换功能任务测试的正确率提高,提示大脑灵活性得到改善,处理问题的效率变高。傅经明等[29]对城乡社区老年人进行12周的八段锦锻炼,结果显示,基本认知能力测验分值、数字记忆广度、数字快速拷贝和汉字旋转3项分测验得分显著提高,干预组的基本认知能力测验总分和数字记忆广度得分高于对照组。以上研究均表明,传统养生体育项目作为一种寓教于乐、简单易行的方式,符合县域老年人的偏好、特点和生活习惯,在县域范围内具有较强的可推广性。
我国城乡高龄老人蛋白质摄入不足率分别为76.7%和87.2%,老年人认知能力下降与营养摄入不足有关[31-32]。Liu等[32]对蛋白质缺乏风险的农村老年人实施12周的营养干预,参与者在原有的饮食方式上服用多营养素大豆粉,其味道和形式接近老年人的饮食习惯和偏好,结果显示试验组MMSE评分、注意力、计算和回忆维度的评分显著提高,77.0%的老年人表示在干预结束后继续服用。研究显示,存在听力损失老年人的定向力得分比正常老年人低,听力损失是潜在的可干预的痴呆危险因素[33]。Lin等[34]对听力受损但无明显认知障碍的城乡老年人进行长达3年的听力干预,包括听力康复、助听器的适配等措施,采取电话随访、评估和相关指导。预设的敏感性分析表明,对认知功能下降和痴呆风险增加的70岁以上的老年人进行听力干预具有重要作用,但在认知功能下降风险较低的人群中则无明显效果。以上研究表明针对认知功能可控性影响因素设计的单一性干预措施可提高农村老年人的认知能力水平,并可引起他们的兴趣,提升接受度。
认知功能的影响因素多样且复杂,认知退化的表现具有多样性,应采取综合性健康促进方案为老年人提供全面的健康管理策略。然而,从城乡角度上看,医疗资源向城市倾斜,农村医疗资源与现实需求不相适应、配置结构失衡、医疗设备简陋落后且短缺、基层卫生人员技术水平较低且流失率升高[13,35],再加上农村老年人受教育水平较低。因此,在开展综合性认知功能健康促进方案时应从低成本、无需特殊设备和培训、易于管理和实施、易被老年人接受和理解等方面着手,以此符合县域地区医疗卫生分布的实际情况和老年人的特点。
认知训练结合身体运动可发挥协同作用,促进神经新生和血管生成,比单一性训练更能改善认知功能、预防神经退行性疾病的发生[36]。研究者对某农村MCI老年人开展身体活动联合认知训练,身体随着音乐及2根竹竿发出的节奏而运动,认知训练涉及注意力、记忆力和执行功能。结果表明受试者注意力改善、记忆力提升、执行功能增强[37]。本研究采用的竹竿符合当地文化、价格便宜且易获取,发挥团体社交的优势,以此提高兴趣度。某高校志愿者团队对乡镇和乡村分别采取“益智服务站”和“益智巴士”的方式为老年人检测认知状况,对老年人实施个性化训练方案,提供认知训练、社交活动和身体锻炼,提高其加工速度、工作记忆和执行功能等方面。自开展以来,已有上万名老年人认知功能明显提高[38]
将良好的生活方式指导纳入脑认知健康管理中是国内外研究者常用的健康促进方案。认知训练联合身体运动和改变生活方式不仅能延缓认知能力水平下降或降低认知功能受损的恶化速度,而且能提高身体活动水平和生活质量、促进社交、改善抑郁情绪。学者强调生活方式是行为改变干预措施的主要目标,旨在降低痴呆症风险和促进健康老龄化[39]。Uemura等[40]对某农村老年人进行两年的主动学习健康教育,主题是运动、饮食和营养以及认知活动,主动学习包括探索性学习、小组讨论和自我规划行为改变。结果显示,老年人平均参与度为90.2%,试验组和对照组在处理速度、工作记忆方面没有显著差异,试验组在类别流畅性测试和风景图片记忆测试的评分显著提高,说明主动学习健康教育在语言和记忆方面有积极影响。Clare等[39]通过访谈获取老年人的需求进而设定与身体、认知和社会活动、营养相关的健康促进行为改变的目标,体现了“以人为中心”的原则,后期进行电话指导来解决所出现的障碍、给予鼓励和支持。经过12个月的干预,受试者总体认知能力有所提高,尤其是即刻回忆和延迟回忆能力改善最大。
随着信息技术的普及与发展,将数字技术应用于医学领域是二十一世纪医学发展的基础和主流方向[41]。数字医学打破了地域局限性、为健康管理提供新的途径、缓解医疗资源压力等问题。老年人使用互联网对认知健康起着关键作用,互联网所呈现的活动可刺激老年人认知[6]。Lee等[42]对某农村老年人开展6个月的数字素养教育,涉及智能手机的基本操作、支付功能、社会交往等,结果显示失智症筛查的幸福感和认知功能评分分别提高了3.7分和1.1分,与对照组相比,试验组的认知功能评分显著提高,智能手机的使用频率和录制视频的能力得以提高。Park等[43]采用线上椅子瑜伽(online chair yoga,OCY)和电脑益智游戏(computer brain game,CBG)对某乡镇ADRD风险老年人进行12周的远程指导和监督。结果显示,OCY组和CBG组老年人的Mini-MoCA总分随时间呈现线性增长,表明两组的认知功能均有所改善,CBG组较OCY组在移动性方面改善明显。Shake等[44]对某农村老年中心开展10周的基于Bingocize©应用程序的健康教育,老年中心的员工经过培训后,对受试者介绍使用规则,游戏上的每个数字对应一个关于骨关节炎和跌倒风险的健康教育问题或身体活动。结果显示,出勤率高达93%以上,试验组在点数计数任务上表现较好,但在其他执行功能测试没有显示出显著的组间差异,可能受到练习效应和时间较短的影响。说明此方案对老年人执行功能的更新方面产生积极的影响。以上研究均表明对于医疗资源和交通受限、偏远地区的老年人而言,数字化健康促进方案可提高他们使用计算机设备的能力、改善他们认知能力水平及心理健康、结合乐龄游戏能高度吸引老年人参与,值得我国县域医疗卫生服务机构借鉴。
根据以往研究可发现国内外学者通过认知功能的可控性因素、考虑地域局限性和认知康复资源受限性来开展县域老年人认知促进健康方案。传统体育项目多由我国学者作为改善老年人认知功能健康的方案之一,认知训练、身体运动、改变生活方式等综合性干预措施是国内外学者常用的健康促进方案。在一定程度上,综合性健康促进方案优于单一性健康促进方案,从多方面提高老年人认知功能、身体活动水平、心理健康和参与度。国外学者已将数字技术应用于认知功能健康促进计划中,通过远程干预和筛查、网络游戏、应用程序等方式,可打破地域局限性、解决县域医疗资源分配不合理、有效提高资源的配置和效率、实现数据信息共享、克服偏远地区无法及时就医等问题。
由于县域卫生资源分布不均、内部医疗资源配置结构失衡、老年人受教育程度较低等特点,因此对县域老年人实施认知功能健康促进策略时应考虑不受地点和时间限制、易于老年人理解和接受、符合当地文化、无需特殊设备和培训、非专业卫生工作者可执行、在县域地区可推广性较高等。近年来,针对县域老年人,我国学者已从简化筛查过程、具有教育公平性、易操作等方面选择认知功能筛查工具,认知功能健康促进方案多集中于传统养生体育项目、单一性和综合性方案,结合数字技术的认知功能健康促进方案尚未见报道。
近年来,老龄化速度加快、程度加深已成为我国新常态,脑健康是助力健康老龄化和实现健康中国的重要部分。数字技术应用于县域医疗领域有助于推动县域医疗行业的信息化进程、实现数据互联互通、有效整合调动医疗资源,来提高资源的利用效率和缓解县域医疗资源配置失衡,实现医疗服务的智能化和精准化。
  • 河南省二○二三年科技发展计划(232102310136)
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2024年第51卷第16期
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doi: 10.20043/j.cnki.MPM.202405054
  • 接收时间:2024-05-06
  • 首发时间:2026-03-18
  • 出版时间:2024-08-25
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  • 收稿日期:2024-05-06
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    河南大学护理与健康学院,河南 开封 475000

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2种不同金属材料的力学参数

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species
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Percentage of
total species (%)

Genus
种数
Number of
species
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Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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